External validation and update of a prognostic model to predict mortality in hospitalized adults with RSV: A retrospective Dutch cohort study. Issue 12 (28th August 2019)

• Record Type: Journal Article
• Authors: Vos, Laura M.; Oosterheert, Jan Jelrik; Hoepelman, Andy I. M.; Bont, Louis J.; Coenjaerts, Frank E. J.; Naaktgeboren, Christiana A.
• Is Part Of: Journal of medical virology. Volume 91:Issue 12(2019)
• Page Start: 2117
• Page End: 2124
• Publication Date: 2019-08-28
• Subjects: adults -- external validation -- mortality -- prognostic -- respiratory infection -- RSV; Virology -- Periodicals; 616
• DOI: 10.1002/jmv.25568
• Languages: English
• ISSNs: 0146-6615

Abstract

Abstract: Respiratory syncytial virus (RSV) causes significant mortality in hospitalized adults. Prediction of poor outcomes improves targeted management and clinical outcomes. We externally validated and updated existing models to predict poor outcome in hospitalized RSV‐infected adults. In this single center, retrospective, observational cohort study, we included hospitalized adults with respiratory tract infections (RTIs) and a positive polymerase chain reaction for RSV (A/B) on respiratory tract samples (2005‐2018). We validated existing prediction models and updated the best discriminating model by revision, recalibration, and incremental value testing. We included 192 RSV‐infected patients (median age 60.7 years, 57% male, 65% immunocompromised, and 43% with lower RTI). Sixteen patients (8%) died within 30 days. During hospitalization, 16 (8%) died, 30 (16%) were admitted to intensive care unit, 21 (11%) needed invasive mechanical ventilation, and 5 (3%) noninvasive positive pressure ventilation. Existing models performed moderately at external validation, with C ‐statistics 0.6 to 0.7 and moderate calibration. Updating to a model including lower RTI, chronic pulmonary disease, temperature, confusion and urea, increased the C ‐statistic to 0.76 (95% confidence interval, 0.61‐0.91) to predict in‐hospital mortality. In conclusion, existing models to predict poor prognosis among hospitalized RSV‐infected adults perform moderately at external validation. A prognostic model may help to identify and treat RSV‐infected adults at high‐risk of death. Highlight: Prediction of poor outcomes among RSV‐infected adults may improve targeted management and clinical outcomes. Existing models to predict poor prognosis among hospitalized RSV‐infected adults perform moderately at external validation. A model including lower RTI, chronic pulmonary disease, temperature, confusion and urea, had a C ‐statistic of 0.76 (95%CI 0.61‐0.91) to predict in‐hospital mortality.